Organization
ABC123 EARLY INTERVENTION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MANDY MANN (OWNER)
(864) 809-7794
Entity
Organization
Contact information
Practice address
123 ALBERTVILLE LN, SHELBY, NC 28152-7717
(864) 809-7794
Mailing address
PO BOX 1733, GAFFNEY, SC 29342-1733
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Enumeration date
02/01/2018
Last updated
10/11/2018
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